Mary** Posted December 9, 2011 Share Posted December 9, 2011 :eyepoppinThe other day we had a patient with Anti-e, Anti-C,Anti-Fya, Anti-Jka, Anti-K and a previously detected Anti-S. His hemoglobin was 8.5. When we informed the doctor that we would have to have our Reference Lab do a Nationwide search, he responded by saying we will give him Benedryl and you can give the "least incompatible"! After I caught my breathe, I got our Pathologist to intervene.The blood was here in about 24 hours and they gave it 3 days later. Somedays, I don't think we will ever be understood! What a day! :bonk: Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 9, 2011 Share Posted December 9, 2011 Oh wow!! :eyepoppin Scary, scary, scary, but not an uncommon belief among the physicians. You know we can give O negative blood for every sort of emergency even when there is a positive antibody screen, right? Please don't let me be sick, oh please, plese, please! Link to comment Share on other sites More sharing options...
JOANBALONE Posted December 9, 2011 Share Posted December 9, 2011 And washing blood removes all antigens! Link to comment Share on other sites More sharing options...
Auntie-D Posted December 9, 2011 Share Posted December 9, 2011 (edited) *face plants*Edit - my favourite is : "Positive antibody screen? Well we'll just give them flying squad - that's suitable for everyone. Right?'Edit 2 - it wasn't a top up for IDA was is????? Edited December 9, 2011 by Auntie-D Link to comment Share on other sites More sharing options...
EDibble Posted December 10, 2011 Share Posted December 10, 2011 Deny, I agree. We techs here have often joked that when we retire, we will start our own retirement home and hand pick the docs and nurses who will take care of us.Just give Benadryl. Right. Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 12, 2011 Share Posted December 12, 2011 I like this idea!! Can I retire there too??? Link to comment Share on other sites More sharing options...
KKidd Posted December 12, 2011 Share Posted December 12, 2011 I calmly informed a doctor on Sunday that the blood would not be available the next day and I wanted him to be able to make an informed decision regarding the surgery date. He said that he didn't care if I had to crawl to the blood center (60 miles away), he wanted the blood on Monday. Don't you jjust love it!! Link to comment Share on other sites More sharing options...
Dr. Pepper Posted December 12, 2011 Share Posted December 12, 2011 It is my fondest hope that my physician daughter did not take what I hope was an elective course in medical school in Arrogance and Intractability. Link to comment Share on other sites More sharing options...
donellda Posted December 12, 2011 Share Posted December 12, 2011 Ha ha! Love it! I love it when we get an anti-U patient and all we can get is frozen cells. The doctor wants the units on hold just in case:/ Link to comment Share on other sites More sharing options...
mrosebug Posted December 13, 2011 Share Posted December 13, 2011 Heck, with an 8.5 Hgb, I would try to avoid transfusion on this patient a little longer anyway. heathervaught 1 Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 13, 2011 Share Posted December 13, 2011 True as long as the patient is not symptomatic. Link to comment Share on other sites More sharing options...
DOGLOVER Posted December 13, 2011 Share Posted December 13, 2011 It is my fondest hope that my physician daughter did not take what I hope was an elective course in medical school in Arrogance and Intractability.All physicians should have to work in a lab in some way before going to medical school. My physician daughter did, as a phlebotomist and as a histology assisstant. It was invaluable to her. She also has told me that she learned her blood banking from me and nothing in medical school about transfusion. She also learned that when she has questions to go to the lab supervisors and ask. She told me that lab people know a lot of medicine. Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 13, 2011 Share Posted December 13, 2011 She also has told me that she learned her blood banking from me and nothing in medical school about transfusion. She also learned that when she has questions to go to the lab supervisors and ask. She told me that lab people know a lot of medicine.Shhhh!! These are all secrets!! In all sincerity it would be invaluable to the physicians as well as to the lab as we would all be closer to the same page. Link to comment Share on other sites More sharing options...
bmarotto Posted December 13, 2011 Share Posted December 13, 2011 Having residents rotate through Blood Bank does have positive results. This past summer, we were informed that two residents (future anesthesiologists) wanted to do a two week elective in Blood Bank. We were notified on June 24th that they would start on July 1st! We scrambled to accommodate them but it was well worth the effort. They learned a lot and recommended the rotation to other residents. They have said nothing but good things about the Blood Bank. Maybe it is my imagination, but we do not seem to be getting as many strange orders (or bad attitude) from residents this year! Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 13, 2011 Share Posted December 13, 2011 In the (very) old days in the UK, any future Pathologists had to rotate through all of the pathology disciplines and cover them on-call. As a result, they really knew what it took and knew what they were doing. Indeed, two of my oldest friends, Paul Griffiths, now a Consultant Histologist, and Greig Monteith, now a General Practitioner, are still well-versed in all disciplines of pathology, have a great respect for technicians, and are still two of my best friends (indeed Griff was my best man when I married Dee).Unfortunately, such training is no longer the case. Link to comment Share on other sites More sharing options...
EDibble Posted December 13, 2011 Share Posted December 13, 2011 I bet your daughter is a wonderful physician. Kudos! Link to comment Share on other sites More sharing options...
Stoogiesfreak Posted February 28, 2012 Share Posted February 28, 2012 That's better than the time a surgeon asked to have 2 O Neg units sent to OR on a patient with an antibody yet to be identified. He assured me that he would not use them until I called to with the "all clear". He needed them just in case things went bad!Anyone want to by some swamp land?John Link to comment Share on other sites More sharing options...
Dr. Pepper Posted February 28, 2012 Share Posted February 28, 2012 We had an old school head nurse, long retired now, who saw no difference between antibodies and antibiotics. Link to comment Share on other sites More sharing options...
Auntie-D Posted February 28, 2012 Share Posted February 28, 2012 That's better than the time a surgeon asked to have 2 O Neg units sent to OR on a patient with an antibody yet to be identified. He assured me that he would not use them until I called to with the "all clear". He needed them just in case things went bad!Anyone want to by some swamp land?JohnDelayed transfusion vs exanguination - delay provision on blood on your own head... Even if the patient does have antibodies. We do not have any right to withhold blood from them in an emergency situation...As long as we make it clear there is a potential for a transfusion reaction then we are covered. Saying that though we wouldn't even do a routine crossmatch 'just in case' unless it was for major surgery, palcenta previa or a AAA. Link to comment Share on other sites More sharing options...
Stoogiesfreak Posted February 28, 2012 Share Posted February 28, 2012 Whoa! Ease Up! Don't misunderstand - this patient was not in a life threatening situation. This was more of a leap before you look situation. The patient never received any blood. This incident was many years ago and by today's standards a Type/Screen would have been sufficient. Delayed transfusion vs exanguination was never an issue in this case - I'm not that hard hearted. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted February 28, 2012 Share Posted February 28, 2012 I know that I have quoted this before on this site, but it could bear with being quoted again."Transfusion has risks, but bleeding to death is fatal."Brian McClelland MB ChB ND Linden FRCP(E) FRCPath, Consultant Haematologist Scottish National Blood Transfusion Service, as a header to his chapter "Who Needs Transfusion?" in A Manual for Blood Conservation (Ed. Dafydd Thomas, John Thompson, Biddy Ridler) 1st edition, 2005, tfm Publishing Ltd. Link to comment Share on other sites More sharing options...
Auntie-D Posted February 28, 2012 Share Posted February 28, 2012 Stoogiesfreak - I was just playing the devil's advocate. The title is Oh So Misunderstood and we all can be without the full information. We all know communication is the key for safe transfusion, but also is reassurance - we had an Obs and Gynae consultant who requested 4 units on every labour bleed. After a chat about just how quickly we could get blood to them if needed, they now only reguest group and screens Link to comment Share on other sites More sharing options...
Stoogiesfreak Posted February 28, 2012 Share Posted February 28, 2012 Interesting you bring that up. We have a OB physician that ordered 2 units on every procedure he performed in OR. After pulling him aside and having an "educational" meeting he now uses the Type and Screen approach. He also had no idea of how fast we could get units to him once we had the T/S finished. He still orders T/S's on all his OR patients, but it sure saves us time not having to crossmatch every patient!Thanks,John Link to comment Share on other sites More sharing options...
janet Posted March 4, 2012 Share Posted March 4, 2012 .............. He still orders T/S's on all his OR patients, but it sure saves us time not having to crossmatch every patient!Thanks,JohnWe have a few surgeons who order G&S on EVERYTHING they do (OBG inserting IUD's!! Orthopod doing knee scopes!!! ENT doing ear tubes!!!). How can we change this type of over-ordering!? Link to comment Share on other sites More sharing options...
tbostock Posted March 4, 2012 Share Posted March 4, 2012 We have a few surgeons who order G&S on EVERYTHING they do (OBG inserting IUD's!! Orthopod doing knee scopes!!! ENT doing ear tubes!!!). How can we change this type of over-ordering!?Come up with a SSBOS (Standard Surgical Blood Order Schedule) which is a list of procedures that need at least a Type and Screen presurgically. It should go to all of the medical divisions for approval (ortho, general surgery, urology, etc). The Pre-Surgical testing folks then use this approved list for who gets Type and Screens ordered. We do allow exceptions for patients with special needs (pts with bleeding disorders, etc). Link to comment Share on other sites More sharing options...
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